Psych Meds Final PDF

Psych Meds Final UNIT ONE Haloperidol -First Gen typical Antipsychotic – control positive sx -used in hallucinations, schizophrenia, Tourette’s -GIVEN W A BENZOS LIKE LORAZEPAM TO CONTROL AGGRESSIVE BEHAVIOR -S/E- normal- cause of EPS (PS, tardive dyskinesia...

Psych Meds Final UNIT ONE Haloperidol -First Gen typical Antipsychotic – control positive sx -used in hallucinations, schizophrenia, Tourette’s -GIVEN W A BENZOS LIKE LORAZEPAM TO CONTROL AGGRESSIVE BEHAVIOR -S/E- normal- cause of EPS (PS, tardive dyskinesia), dystonia, sedation- use benztropine to reduce EPS -DANGER W NEUROLEPTIC MALIGNANT SYNDROME- HIGH FEVER, TREMORS, - HOLD, ASSESS, PP- DANTRALINE IF SX Diphenhydramine -Antihistamines – 1st gen -S/E- sedation, urinary retention- cant see, cant pee, cant poop -has a sedating effect- PREVENT DYSTONIC RXN Midazolam - Acts fast within minutes - Highly addictive and not safe for long term use - S/E- SEDATION, SLEEPY, SUPRESSION OF ABC - -don’t skip, take at bedtime - Taper off/ no dangerous tasks Olanzapine -Second Gen Atypical Antipsychotic - control the positive and the negative sx from schizophrenia (-)- no energy, no motivation -S/E- weight gain, decreased libido, neutropenia, monitor bg and sx of infection Ziprasidone -Atypical antipsychotic -balance levels of dopamine in the brain ANTI-ANXIETY MEDS: Hydroxyzine (Atarax, Vistaril) - Antihistamine- PRN - 15-30 mins to start working - S/E- dry mouth, drowsiness - Dose- 25-50 mg 4 times a day, max dose 100 mg Lorazepam (Ativan) - Benzodiazepine (Short to intermediate acting)- PRN - 20-40 mins to work- lasts for 4-6 hrs - S/E- drowsiness, sedation - Dose- oral 0.5-2 mg, 2-3 times per day w max of 10 mg/day  Clonazepam (Klonopin) - Benzodiazepine (Intermediate to long acting)-PRN - 20-40 mins to work- lasts for 6-12 hrs - S/E- ataxia (unsteady gait), dizziness, drowsiness - Dose- oral- 0.25-1 mg, 1-2 times daily w max of 4 mg/day Fluoxetine (Prozac) -SSRI- stops serotonin from reabsorbing -may need 2-12 weeks to see improvement -S/E- decreased libido, sexual disorder, D/N, xerostomia- dry mouth, HA, insomnia, tremor, yawning -Dose- oral 10-20 mg once in AM w max of 60 mg/day Propranolol (Inderal) - Beta Blocker- PRN - 30-60 mins to work- lasts for 6-12 hrs - S/E- hypotension - Dose- oral 10-20 mg 30 to 60 mins prior to anxiety provoking situation BENZOS- dangerous bc of sedation, make vitals low UNIT TWO MEDS UNIT TWO Antipsychotics: all tx psychosis and agitation: First Gen: Typical Haloperidol AND Fluphenazine: Decrease dopamine+ tx positive sx Side effects- Anticholinergic effects- dry mouth, constipation, blurry vision, urinary retention Severe neurological symptoms: EPS, Tardive dyskinesia, Seizures, NMS Second Gen/ Atypical: Aripiprazole Chlorpromazine- cause agranulocytosis Olanzapine Risperidone- increase prolactin Quetiapine  Ziprasidone- 500 cals, prolongs QTC Clozapine -neutropenia , agranulocytosis DECREASE dopamine AND INCREASE serotonin Side effects- Anticholinergic effects- dry mouth, constipation, blurry vision, urinary retention Neurological- EPS (akathisia, dystonia), NMS Endocrine/ Metabolic- hyperglycemia, diabetes, elevated prolactin (risperidone), high cholesterol, triglycerides, weight gain Cardiac- tachycardia, HTN, orthostatic hypotension, EKG changes (prolongs QTC), myocarditis Blood dyscrasias- agranulocytosis- very low WBC Propranolol is a beta-blocker medication that can be used in psychiatry to treat a number of conditions, including: Anxiety disorders: Propranolol can help with the physical symptoms of anxiety, such as sweating and shaking, without treating the feeling of anxiety itself. It can also be used to treat performance anxiety, which is a type of social phobia. Post-traumatic stress disorder (PTSD): Other psychoses: Propranolol has been investigated as a treatment for other psychoses. Benztropine, Diphenhydramine: used to treat EPS, especially dystonia Benztropine (PO- IM less available) Diphenhydramine (PO & IM) Anticholinergic side effects (esp. large doses)- dry mouth, blurry vision, urinary retention ANTIDEPRESSANTS: Amitriptyline: TCA- older- used for sleep or when other meds did not work  Tricyclic Side effects Decrease blood pressure; drowsiness; lethal in overdose, Dry mouth, blurred vision, constipation, orthostatic hypotension, weight gain, sexual dysfunction, increased risk of seizures, toxicity in overdose, SEDATION, decreased seizure threshold, drug levels can be obtained- HIGH SIDE EFFECT PROFILE- ANTICHOLINERGIC SE -use- MDD, neuropathic pain, fibromyalgia, insomnia Selegiline, Phenelzin MAOI- older; rarely used Monoamine oxidase inhibitors Interacts with almost all other medications Special diet: Low tyramine Tyramine plus MAOI= hypertensive crisis, stroke, death Side Effects: Orthostatic hypotension, dizziness, drowsiness, insomnia, sexual dysfunction, weight gain, hypertensive crisis AVOID- pickled, fermented food, cheese, wine, alcohol- sharcotery (idk how to spell) board- TYREMINE CONNECTION NO FOOD W TYREMINE- Can cause hypertensive crisis Serotonin syndrome- MAoi- Massive HTN crisis, A- avoid tyramine Fluoxetine, Sertraline, Citalopram: - SSRI, first line tx for depression Selective Serotonin reuptake inhibitors Side effects: GI (NVD, dry mouth), weight changes, sexual dysfunction, SERATONIN SYNDROME, sexual SE (more longer SE that does not go away), stomach GI upset disturbance, sleep disturbances more common on onset of tx., take 4-6 weeks to see full therapeutic effect, fewer SE than TCA, taken in the morning to avoid sleep disturbances Venlafaxine, Duloxetine: SNRI, Second line for depression- DO NOT COMBINE WITH SSRI  Serotonin & Norepinephrine reuptake inhibitors Side effects: Tachycardia, HTN, insomnia, anxiety, dry mouth, headache, constipation (Also: NVD & sexual dysfunction but less than SSRIs), Nausea, diarrhea, decreased libido, erectile dysfunction, weight gain, dizziness, drowsiness, headache, insomnia, serotonin syndrome, MANIA without a mood stabilizer Complications: withdrawal syndrome FINISH- flu like sx, insomnia, nausea, imbalance, sensory disturbances, hyperarousal Bupropion- can be used w SSRI Norepinephrine & Dopamine reuptake inhibitors Side effects: Insomnia, seizure, headache, weight loss, anxiety, dry mouth, constipation, NV Indication- depression, adhd, smoking cessation -moa- Shifts the levels of dopamine and norepinephrine in the brain SE- Gastrointestinal issues, orthostatic hypotension, sedation, weight loss, sexual dysfunction, increased risk of seizures - -CI-No alcohol, not used in eating disorders- seizures Mood Stabilizers: Lithium- Therapeutic range: 0.6-1.2, higher than 1.5- toxicity Trough blood level (section 4.2): 1.2-1.4- toxicity- 1.5-2.5, severe 2.5-3.5 mEq/L Side effects: tremors, KIDNEYS Drug interactions: -avoid- ACE/ARBS/BBC/CCB, diuretics, NSAIDS Toxicity: seizures, metallic taste in mouth, dehydration, d/n/v, tremors, renal failure, coma, death, slurred speech -monitor kidney fcn, thyroid fcn (More frequent with onset, less frequent as progresses) Levels- 12 hrs after the last dose- through levels -don’t take morning dose prior to obtaining labs- NEED BLOOD WORK -NO EPS -yes- tremors, seizure risk, complications Divalproex Sodium- Valproate – anticonvulsant – mood stabilizer Therapeutic range: 50-125, toxic 150 and greater Side effects: sedation, thrombocytopenia, hepatoxicity, bone marrow suppression Check liver fcn, GI sx, alopecia Works- if mood is stabilized, MSE NOT USED IN WOMAN OF CHILD BEARING AGE LIVER LABS-USED IN BIPOLAR DISORDER Lamotrigine Side effects: steven johnson’s syndrome- start low and slow Most life threatening rashes- 1st 2-8 wks Starts at mouth usually Nursing interventions for the client with Bipolar Disorder: Maintenance- take meds, get blood work done, connect with support system ANTIPSYCHOTICS First Generation/ Typical Second Generation/ Atypical Decrease Dopamine Decrease Dopamine & Increase Serotonin Haloperidol Aripiprazole Fluphenazine Clozapine** Agranulocytosis Olanzapine Risperidone *increases prolactin Quetiapine Ziprasidone * 500 calories; prolongs QTC ANTIDPRESSANTS Amitriptyline: TCA- older- used for sleep or when other meds did not work Selegiline, Phenelzin MAOI- older; rarely used Fluoxetine, Sertraline, Citalopram: - SSRI, first line tx for depression Venlafaxine, Duloxetine: SNRI, Second line for depression- DO NOT COMBINE WITH SSRI Bupropion- can be used w SSRI Mood Stabilizers: Lithium- Therapeutic range: 0.6-1.2, higher than 1.5- toxicity Divalproex Sodium- Valproate – anticonvulsant – mood stabilizer Lamotrigine MEDS UNIT THREE CNS Stimulants - Risk- abuse, misuse, growth suppression, mania, psychosis, hallucinations, tics, decreased neutrophils Methylphenidate- - Short acting, immediate release- take 2-3 times per day - Intermediate, long acting, transdermal Dextroamphetamine, Dextroamphetamine-Amphetamine- Adderall Non-Stimulant- Atomoxetine- SNRI -second line- used if stimulants give too much of a SE/intolerance -SE- HTN, tachycardia, insomnia, HA, GI sx, erectile dysfunction Antihypertensives (alpha agonists) Clonidine- oral/transdermal SE- hypotension, drowsiness, rebound hypertension as withdrawal, dermatitis Guanfacine SE- hypotension, drowsiness, rebound HTN, Uncommon SE- cardiac AV block, SA block, palpitations Substance use disorder meds: Alc withdrawal: DO NOT TAKE Bupropion- BC OF SEIZURE RISK- W ALC WITHDRAW Naltrexone- PO, IM med, opioid antagonist SE- usually well tolerated, GI effects, effect on LFT but should trend down -REDUCES THE CRAVING FOR ALCOHOL, DECREASES THE EFFECT Disulfiram -will make the person feel sick if they drink alc -the rxn will prevent person from drinking alc while on this med Acamprosate- dosed 3x per day, less common - Reduces sx of withdrawal - Alc Withdrawal- TREATED W BENZOS - Chlordiazepoxide, Lorazepam, Diazepam Also possible use of anticonvulsant- Phenobarbital (BENZOS withdrawal- treated w Benzos) Opioid withdrawal meds: Naloxone- poor oral availability, opioid antagonist - Used in opioid overdose Methadone- used for withdrawal- full opioid agonist -stops withdrawal, long half life, needs to be started low and increasing slow -also used for chronic pain- PO -for withdrawal- LIQUID form -SE- resp depression, constipation, sedation, hyperhidrosis -DO NOT USE IF QTC PROLONGATION IS PRESENT - has NO ceiling effect Buprenorphine- used in medication-assisted treatment (MAT) to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. Withdrawal from Nicotine: Nicotine gum, lozenge, patch - NOT LIKE REGULAR CHEWING GUM -bite down slowly until tingling is felt on mouth, then place gum between cheek and gums, repeat the placing for 30 mins until tingling stops